Provider Demographics
NPI:1487342382
Name:SOUZA, ISABELA
Entity type:Individual
Prefix:
First Name:ISABELA
Middle Name:
Last Name:SOUZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 PINES BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6139
Mailing Address - Country:US
Mailing Address - Phone:929-515-4335
Mailing Address - Fax:
Practice Address - Street 1:9960 PINES BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6139
Practice Address - Country:US
Practice Address - Phone:754-331-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29527122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist